Republicans in Congress are going forward with replacing Obamacare with a bill they have titled the American Health Care Act (AHCA), released earlier this month. Additionally, changes in the bill are scheduled to be announced soon. The introduction of the bill, AHCA, seems to have divided Congress and the Senate into three factions, namely those among Republicans who believe the bill is Obamacare Lite, those Republicans who support enacting AHCA, and most Democrats who believe the bill would be worse than Obamacare and prefer to keep Barack Obama’s signature health care law in place as it is now.
The debate is quite divisive among Republicans who say the AHCA is Obamacare Lite, and that Republican leaders are betraying their promise to the voters to repeal Obamacare. The conservative base in the GOP seems heavily aligned with this point of view and among grassroots conservatives, the leadership’s health care bill is both Obamacare Lite and constitutes breaking of their promise to repeal Obamacare. Since they can count on few or not Democratic members to pass AHCA, the GOP leadership needs just about all of their members in both houses to vote with them in passing AHCA.
The primary critics of the AHCA bill are Sens. Rand Paul (R-KY), Mike Lee (R-UT) and Ted Cruz (R-TX). If those senators can get one more senator to vote against AHCA, given that Republicans had 53 seats in the Senate, and no Democrats vote for the bill, it would lose by one vote in the Senate. Likewise, if most or all of the 30-something members of the House Freedom Caucus in Congress vote against AHCA, it would fail to pass there.
The stakes are extremely high in this debate over how to address or fix the overall health care mess created by the Democrats when they passed Obamacare. But there is great risk, politically, and in what will be done to the country, in what ends up passing or not passing as well.
The strategy for Democrats is easy, they can just sit back and defend Obamacare and vote against anything and everything Republicans propose. Just as they passed Obamacare almost entirely without Republican votes in Congress and the Senate in 2010, they can sit back and let Republicans struggle to solve the problem with the support of their members only. Certainly this strategy by the Democrats won’t sit well with those who demand bipartisanship and both parties working together to solve the problem. However, is health care reform turns out to be a political disaster for Republicans, few will remember that Democrats opted to take a hands-off approach if the Republicans make a worse mess of the health care situation. And that is very possible, likely according to the view held by many of the GOP leadership’s AHCA approach to health care reform, or perhaps Obamacare reform.
Republicans now are being held accountable to governing, since they won the majorities in both houses of Congress and the presidency in the form of President Donald Trump. The public expects Congress and President Trump to repeal Obamacare, and to also replace it with something that will work much better. They say AHCA is just that, but a large percentage of Republican voters, and some members in both houses of Congress, disagree and view the leadership’s bill as Obamacare Lite, or as some are calling it, even worse, RINOcare. RINO in this usage stands for a derogatory label of moderate Republicans as “Republicans In Name Only.”
If they fail to pass AHCA, or any other legislation to address this issue, Republicans will have certainly broken their promise to repeal Obamacare, and will stand to likely pay the price politically in 2018 and perhaps also 2020 as well. If they enact AHCA, and President Trump signs it into law, will it really be better than Obamacare, and address the key issues that need to be address in health care reform? Or will it be seen by the voters as tinkering with or making small changes in Obamacare, and therefore will Republicans be seen by many voters as breaking their promise to repeal Obamacare by having passed AHCA? If the latter is the case, Republicans might still pay the price for not repealing Obamacare, and replacing it with what many may ultimately see as Obamacare Lite.
If the AHCA is sufficiently changed to be seen as repealing most if not all of Obamacare to replace it with something else, then Republicans might be seen as holding up to their campaign promises on this issue. Speaker Ryan says he has the votes to pass their bill, so it remains to be seen if that happens, and the Republican Senate under Mitch McConnell can find at least 50 votes to allow Vice President Mike Pence to break a tie and pass the bill.
A win-win for both sound public policy and good politics on health care reform for Republicans would be to immediately pass legislation to repeal Obamacare and put that on President Trump’s desk, and minutes later pass the replacement. The replacement would be simple: enact the Medical Savings Accounts idea as suggested by Ben Carson at the National Prayer Breakfast in 2013, allows sales of insurance across state lines, and address the issues of pre-existing conditions, preferably taking a free market approach to fix that issue.
That kind of approach would be accepted by most Americans, it would work in improving the health care of all Americans, and Republicans will be seen as keeping their campaign promises. Not a single Democrat will vote for that, but it doesn’t need any Democratic members to vote for it if at least 50 Republicans Senators and 218 Republicans in Congress vote for it. Then President Trump would sign it.